Obesity Policy Research Articles

Harnessing the persuasive potential of data: The combinatory effects of data visualization and interactive narratives on obesity perceptions and policy attitudes

Data visualization has become a useful tool for website designers to effectively present complicated statistical information. In the context of health communication, however, the collective nature of aggregated data may hinder users from empathizing with individuals who suffer from a health issue. This study attempts to provide a solution to the limitation, by adding an interactive personal narrative to visualization of obesity data. Given the lack of empirical research that investigates why data visualization influences user engagement, the current study examines interactivity as an underlying mechanism. The level of interactivity in data visualization (low vs. high) was varied, along with the level of interactivity in a narrative of an obese character (low vs. high) in a 2 × 2 factorial-design experiment with 385 valid participants. Results showed that increased message interactivity for the narrative, presented with increased modality interactivity for data visualization, led to a greater empathic perception of obese individuals’ hardships and greater perceived severity of obesity, and less defensive responses to the website. As a result, high interactivity in data visualization showed significant indirect effects on participants’ attitudes toward policy change, only when presented with the highly interactive narrative.

Using Obesity Research to Shape Obesity Policy in Minnesota: Stakeholder Insights and Feasibility of Recommendations.

Preventing childhood obesity requires innovative, evidence-based policy approaches. This study examines the use of research evidence by obesity policy stakeholders in Minnesota and develops pilot tools for communicating timely evidence to policymakers. From November 2012 to January 2013, semistructured interviews were conducted with 51 Minnesota stakeholders in childhood obesity prevention. Interviewees included 16 state legislators and staff; 16 personnel from the Minnesota Department of Education, Minnesota Department of Health, and Minnesota Department of Transportation; and 19 advocates for and against childhood obesity prevention legislation (response rate = 71%). Participants were asked their views on 3 themes: (1) Whether and how they used research evidence in their current decision-making processes; (2) barriers to using research evidence for policymaking; and (3) suggestions for improving the evidence translation process. All interviews were audio-recorded and transcribed. A team approach to qualitative analysis was used to summarize themes, compare findings across interviewees' professional roles, and highlight unexpected findings, areas of tension, or illuminating quotes. Stakeholders used research evidence to support policy decisions, educate the public, and overcome value-based arguments. Common challenges included the amount and complexity of research produced and limited relationships between researchers and decision makers. Responding to interviewee recommendations, we developed and assessed 2 pilot tools: a directory of research experts and a series of research webinars on topics related to childhood obesity. Stakeholders found these materials relevant and high-quality but expressed uncertainty about using them in making policy decisions. Stakeholders believe that research evidence should inform the design of programs and policies for childhood obesity prevention; however, many lack the time and resources to consult research consistently. Future efforts to facilitate evidence-informed policymaking should emphasize approaches to designing and presenting research that better meets the needs of policy and programmatic decision makers.

Including the voices of children and young people in health policy development: An Irish perspective

Objective: This paper presents findings of a qualitative study which explored children and young people’s understanding of health and the factors that contribute, or act as barriers, to healthy lifestyles. Views were elicited from consultations with children and young people as part of the process for the development of a National Obesity Policy in Ireland. Design: Child participatory methodology was used which prioritised the voice of the child in policy making. Methods: Two consultations were held – one with 48 children between the ages of 8 and 12 and the other with 34 young people aged 13–17 years. The consultations utilised qualitative participatory methodology which prioritised the voices of children and young people in policy making. A diverse range of methodological tools (e.g. ‘lifelines’, ‘body maps’, world café workshops) were used to collect data and optimise levels of participant engagement. Qualitative visual and written data produced during the consultations was then subjected to thematic analysis. Results: Children and young people’s constructions of health and healthy lifestyles are multifaceted. Participants in the consultation appeared well informed as to the general factors which contribute to healthy and unhealthy lifestyles. There were notable differences of emphasis related to age, with the older age group engaging more with issues relating to mental health and peer relationships, while younger children focused more on balanced diet and exercise. Conclusion: Findings from this consultation suggest that children’s constructions of health, and their understandings of the factors that impact health, are complex and often go beyond medical constructions of the meaning of health. The consultation informed the development of the new National Obesity Policy in a number of ways, including specific actions in relation to the development of a whole school healthy lifestyles programme, developing a health and well-being model for early childhood services, and providing clinical services specifically for children.

Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First.

The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies. Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.

How feasible is the life expectancy target in the Saudi Arabian vision for 2030?

Over the period 2016-2030, Saudi Arabia seeks to increase life expectancy at birth by 6 years. The main aim was to analyse the feasibility of this gain using the demographic literature. The demographic literature on recorded high gains in life expectancy and the determinants of these gains were reviewed. The findings were examined considering the Saudi Arabian context. Explanations covered demographic and behavioural factors, inequalities, health care delivery system, public health provision, health-related policies and advancements in science and technology. However, the crucial factor is the country's position in the "cardiovascular revolution" (which combines smoking prevalence, obesity, lifestyle and related policies). In countries where life expectancy is in the 70s, average yearly gains are less than 0.31 years, much lower that the Saudi Arabian target of 0.43 years. For Saudi Arabia, an average yearly gain of about half this is achievable provided the fundamental drivers of life expectancy are addressed.

Desire or Disease? Framing Obesity to Influence Attributions of Responsibility and Policy Support

ABSTRACTThe way we describe health threats affects perceptions of severity and preferred solutions to reduce risk. Most people agree obesity is a problem, but differ in how they attribute responsibility for development and decline of the disease. We explored effects of message framing on attributions of responsibility and support for public obesity policies using a 3 × 2 factorial design. Participants read one of six versions of a health message describing the negative effects of obesity. Message frames influenced respondent attributions and their support for policies to reduce obesity. Those who read a message that assigned agency to the disease (e.g., Obesity causes health problems) endorsed genetics as the cause to a greater degree than those who read a semantically equivalent message that instead assigned agency to people (e.g., Obese people develop health problems). In contrast, assigning agency to people rather than to the disease prompted higher attributions of individual responsibility and support for public policies. Explicit message frames that directly connected responsibility for obesity to either individual or societal factors had no effect on respondent perceptions. Findings suggest explicit arguments may be less effective in shifting perceptions of health threats than arguments embedded in agentic message frames. The results demonstrate specific message features that influence how people attribute responsibility for the onset and solution of obesity.

Public Beliefs About Obesity Relative to Other Major Health Risks: Representative Cross-Sectional Surveys in the USA, the UK, and Germany.

Overweight and obesity are among the leading risk factors for death worldwide. Scientists believe that the increase in obesity is primarily due to environmental changes and thus favor obesity prevention measures targeting the environment. However, it is less clear what lay people perceive as causes of obesity, and which measures they deem acceptable and promising in fighting it. This article compares lay beliefs about obesity with beliefs about other major health risks sharing certain similarities with obesity (alcohol and tobacco dependence, depression) in three countries with high obesity rates. Computer-assisted face-to-face interviews with representative samples in the UK (N = 1,216) and Germany (N = 973) and an online survey in the USA (N = 982) tapping beliefs about locus of responsibility, liability for treatment costs, and effectiveness of policy measures. In each country, respondents attributed responsibility for obesity primarily to the individual; the same pattern emerged for alcohol and tobacco dependence, but not for depression (ps < .01). The higher the attribution of personal responsibility, the more strongly respondents endorsed individual liability for treatment costs (ps < .01). Respondents judged information and fiscal policies as most and least effective, respectively, in obesity prevention. Respondents' views about obesity are similar to those about addictions; however, they regard fiscal and regulatory policies as less effective for obesity than for addictions. Raising awareness about environmental drivers of obesity and framing policy measures by reference to the fight against tobacco and alcohol could increase public support of obesity-targeted policies.

Changes in acyl ghrelin, insulin and leptin of young obese Indonesians following a 4-weeks weight loss program

Changes in acyl ghrelin, insulin and leptin of young obese Indonesians following a 4-weeks weight loss program

Childhood obesity policies – mighty concerns, meek reactions

The increasing number of children defined as overweight or obese is causing concern among politicians and health advocates; several countries have launched policies addressing the issue. The paper presents an analysis of how the childhood obesity is defined, explained and suggested policies to address the problem from the WHO, the EU, Canada, England and New Zealand. Considering the dramatic language used when describing childhood obesity, the proposed interventions are modest. Either the politicians do not consider the problem that great after all, or other concerns, such as the freedom of the food and drink industry and local authorities, are seen as more important. The causes identified are multiple and varied, including the physical and commercial environment, whereas the interventions primarily address the information level of the population, placing responsibility on the shoulders of the parents. Only the World Health Organization argues that statutory measures are required, and the English Government suggests one: a levy on sugary drinks. Otherwise, local authorities, schools and the industry are expected to act on a voluntary basis. Very little is explicitly substantiated by evidence, and the evidence cited is sometimes misinterpreted or disregarded. There is a discrepancy between how the problem of childhood obesity is presented as alarming and the modest measures suggested.

Examining the validity and utility of two secondary sources of food environment data against street audits in England

BackgroundSecondary data containing the locations of food outlets is increasingly used in nutrition and obesity research and policy. However, evidence evaluating these data is limited. This study validates two sources of secondary food environment data: Ordnance Survey Points of Interest data (POI) and food hygiene data from the Food Standards Agency (FSA), against street audits in England and appraises the utility of these data.MethodsAudits were conducted across 52 Lower Super Output Areas in England. All streets within each Lower Super Output Area were covered to identify the name and street address of all food outlets therein. Audit-identified outlets were matched to outlets in the POI and FSA data to identify true positives (TP: outlets in both the audits and the POI/FSA data), false positives (FP: outlets in the POI/FSA data only) and false negatives (FN: outlets in the audits only). Agreement was assessed using positive predictive values (PPV: TP/(TP + FP)) and sensitivities (TP/(TP + FN)). Variations in sensitivities and PPVs across environment and outlet types were assessed using multi-level logistic regression. Proprietary classifications within the POI data were additionally used to classify outlets, and agreement between audit-derived and POI-derived classifications was assessed.ResultsStreet audits identified 1172 outlets, compared to 1100 and 1082 for POI and FSA respectively. PPVs were statistically significantly higher for FSA (0.91, CI: 0.89–0.93) than for POI (0.86, CI: 0.84–0.88). However, sensitivity values were not different between the two datasets. Sensitivity and PPVs varied across outlet types for both datasets. Without accounting for this, POI had statistically significantly better PPVs in rural and affluent areas. After accounting for variability across outlet types, FSA had statistically significantly better sensitivity in rural areas and worse sensitivity in rural middle affluence areas (relative to deprived). Audit-derived and POI-derived classifications exhibited substantial agreement (p < 0.001; Kappa = 0.66, CI: 0.63–0.70).ConclusionsPOI and FSA data have good agreement with street audits; although both datasets had geographic biases which may need to be accounted for in analyses. Use of POI proprietary classifications is an accurate method for classifying outlets, providing time savings compared to manual classification of outlets.

Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice.

In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. In 2008, using information from peer-reviewed reports and quantitative estimates by experts in childhood obesity, physical activity, nutrition, and health economics and policy, a group of legislators, legislative staff members, and experts trained in systems thinking and system dynamics modeling constructed a model simulating the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Use of the 2008 model contributed to passage of a bill requiring annual fitness testing of schoolchildren and stricter enforcement of physical education requirements. We updated the model in 2014. With no policy change, the updated model projects that the prevalence of obesity among children and adolescents aged ≤18 in Georgia would hold at 18% from 2014 through 2034. Mandating daily school physical education (which would reduce prevalence to 12%) and integrating moderate to vigorous physical activity into elementary classrooms (which would reduce prevalence to 10%) would have the largest projected impact. Enacting all policies simultaneously would lower the prevalence of childhood obesity from 18% to 3%. Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.

Factors Affecting Nutrition and Physical Activity Behaviors of Hispanic Families With Young Children: Implications for Obesity Policies and Programs

ObjectiveTo determine preferred policies and programs to prevent obesity and diabetes as identified by parents and caregivers of 3- to 5-year-old Latino children. DesignConstructs from the Social Ecological Model were used to develop 10 focus group and key informant interview questions. SettingCommunity venues and schools in St Paul, MN. ParticipantsA total of 64 parents and caregivers and 20 key informants provided comments. Intervention(s)Community-based participatory research methods were used to gather opinions regarding appropriate and preferred methods to prevent obesity and diabetes among Latino youth. Native Spanish-speaking investigators who were members of the community conducted 7 focus groups (60–90 minutes each) and 20 key informant interviews. Main Outcome MeasuresThemes and subthemes of preferences based on participant comments. AnalysisTranscript-based, long-table qualitative analysis. ResultsFive themes were identified: (1) cultural beliefs and practices are inconsistent with obesity prevention; (2) cost and convenience; (3) positive parenting practices; (4) we want to learn more about being healthy; and (5) gardens, parks, gyms, and school meals. At least 1 theme fell within each of the Social Ecological Model domains. Conclusions and ImplicationsOur results suggest that parents of young Hispanic children prefer that obesity and diabetes prevention programs address multiple levels of influence.

Prevention of childhood obesity and food policies in Latin America: from research to practice.

Addressing childhood obesity in Latin America requires a package of multisectoral, evidence-based policies that enable environments conducive to healthy lifestyles. Identify and examine key elements to translating research into effective obesity policies in Latin America. We examined obesity prevention policies through case studies developed with an expert in the specific policy. Policies were selected based on their level of implementation, visibility and potential impact to reduce childhood obesity. They include: (i) excise taxes on sugar sweetened beverages and energy-dense foods; (ii) front-of-package food label legislation; (iii) trans fatty acids removal from processed foods; and (iv) Ciclovías recreativas or 'open streets'. Case studies were coded to identify components that explained successful implementation and sustainability using the Complex Adaptive Health Systems framework. The analysis identified key elements for effective and sustainable policy, including evidence justifying policy; evidence-based advocacy by civil society; political will; and legislation and skillful negotiations across government, academia, the private sector and civil society. Scientific evidence and evaluation played an important role in achieving tipping points for policies' launch and sustain effective implementation. Well-coordinated, intersectoral partnerships are needed to successfully implement evidence-based anti-obesity policies. Prospective policy research may be useful for advancing knowledge translation.

Obesity prevention advocacy in Australia: an analysis of policy impact on autonomy

Objective:To explore obesity policy options recommended by stakeholders and identify their impact on individual autotomy. Methods:Qualitative and quantitative methods were used. A content analysis of submissions to the Australian Government's Inquiry into Obesity was conducted. Each recommendation was categorised by its impact on autonomy, according to existing frameworks. Chi‐square test for independence was used to explore the association between autonomy and stakeholder support defined as frequency of recommendation. Results:The extent of support for a policy option was significantly associated with impact on autonomy (p<0.001). Options that reduce autonomy were least frequently recommended in every setting; but more likely in schools (27%) than other settings (<1%). Recommendations to provide incentives (9%) were more common than disincentives (2%) or restrictions (3%), and those that enhance autonomy were most widely recommended (46%). Conclusions:Stakeholders advocated policy options that enhance individual autonomy to a greater extent than those that diminish autonomy. Implications for public health:Targeting obesity policy options that enhance rather than diminish autonomy may be more politically acceptable across most settings, with the exception of schools where more restrictive policy options are appropriate. Re‐framing options accordingly may improve leadership by government in obesity policy.

The development of scientific evidence for health policies for obesity: why and how?

Potential obesity-related policy approaches have recently been receiving more attention. Although some have been implemented and others only proposed, few have been formally evaluated. We discuss the relevance, and in some cases irrelevance, of some of the types of evidence that are often brought to bear in considering obesity-related policy decisions. We discuss major methods used to generate such evidence, emphasizing study design and the varying quality of the evidence obtained. Third, we consider what the standards of evidence should be in various contexts, who ought to set those standards, as well as the inherent subjectivity involved in making policy decisions. Finally, we suggest greater transparency from both academics and policymakers in the acknowledgment of subjectivities so they can distinguish and communicate the roles of empirical evidence and subjective values in the formulation of policy.

Contextualizing Obesity and Diabetes Policy: Exploring a Nested Statistical and Constructivist Approach at the Cross-National and Subnational Government Level in the United States and Brazil.

Background: This article conducts a comparative national and subnational government analysis of the political, economic, and ideational constructivist contextual factors facilitating the adoption of obesity and diabetes policy. Methods: We adopt a nested analytical approach to policy analysis, which combines cross-national statistical analysis with subnational case study comparisons to examine theoretical prepositions and discover alternative contextual factors; this was combined with an ideational constructivist approach to policy-making. Results: Contrary to the existing literature, we found that with the exception of cross-national statistical differences in access to healthcare infrastructural resources, the growing burden of obesity and diabetes, rising healthcare costs and increased citizens’ knowledge had no predictive affect on the adoption of obesity and diabetes policy. We then turned to a subnational comparative analysis of the states of Mississippi in the United States and Rio Grande do Norte in Brazil to further assess the importance of infrastructural resources, at two units of analysis: the state governments versus rural municipal governments. Qualitative evidence suggests that differences in subnational healthcare infrastructural resources were insufficient for explaining policy reform processes, highlighting instead other potentially important factors, such as state-civil societal relationships and policy diffusion in Mississippi, federal policy intervention in Rio Grande do Norte, and politicians’ social construction of obesity and the resulting differences in policy roles assigned to the central government. Conclusion: We conclude by underscoring the complexity of subnational policy responses to obesity and diabetes, the importance of combining resource and constructivist analysis for better understanding the context of policy reform, while underscoring the potential lessons that the United States can learn from Brazil.

What are the challenges in developing effective health policies for obesity?

Identifying and implementing thoughtful, evidence-based (or at least evidence-informed) public health approaches to influencing obesity is a complex issue fraught with multiple challenges. These challenges begin with determining whether obesity policy approaches should be implemented. This is considered within the broader context of how common public health policy approaches may be relevant and applied to obesity. Additional challenges discussed include inconsistencies in clearly identifying obesity policy targets (for example, prevention versus treatment), selection of appropriate intervention targets and the identification and measurement of meaningful outcomes. Current policy initiatives are drawn upon to illustrate these challenges in the context of promoting solution-focused dialog aimed toward improving current initiatives and informing the development of new programs.

Economics and obesity policy.

This paper elucidates the challenges surrounding the economics of some popular obesity-related policy proposals. Solid economic justifications for anti-obesity policies are often lacking, and evidence suggests policies like fat and soda taxes or restrictions on food stamp spending are unlikely to substantively affect obesity prevalence. In short, many of the same factors that make obesity such a complicated and multifaceted issue extend to the economic analysis of public health policies.

Obesity and public policies: the Brazilian government's definitions and strategies.

The study analyzes national strategies for dealing with obesity in Brazil in the framework of the Brazilian Unified National Health System (SUS) and the Food and Nutritional Security System (SISAN). Based on the document analysis method, we examined government documents produced in the last 15 years in the following dimensions: definitions of obesity, proposed actions, and strategies for linkage between sectors. In the SUS, obesity is approached as both a risk factor and a disease, with individual and social/environmental approaches aimed at changing eating practices and physical activity. In the SISAN, obesity is also conceived as a social problem involving food insecurity, and new modes of producing, marketing, and consuming foods are proposed to change eating practices in an integrated way. Proposals in the SUS point to an integrated and intra-sector approach to obesity, while those in SISAN emphasize the problem's inter-sector nature from an expanded perspective that challenges the prevailing sector-based institutional structures.

Why do Organizations Focus on Health Equity in their Childhood Obesity Policy Work?

Why do Organizations Focus on Health Equity in their Childhood Obesity Policy Work?